Uso de microvibración e inhibidores de la catepsina K en tratamientos de regeneración ósea dental / Use of micro-vibration and cathepsin K inhibitors in dental bone regeneration treatments

Introducción: el hueso está en remodelación constante para mantener la estructura del esqueleto, tener un ciclo de resorción por los osteoclastos y formación de hueso nuevo a cargo de los osteoblastos; el hueso también es susceptible a enfermedades sistémicas, traumas, edad y trastornos genéticos que afectarán el remodelado óseo, produciendo una pérdida masiva de masa ósea regulado por hormonas, citocinas, enzimas, etcétera. El objetivo es realizar una revisión sistemática de artículos que muestren cambio o alteración al utilizar tratamientos con microvibraciones y farmacológicos sobre la catepsina K en el hueso alveolar. Material y métodos: para realizar una comparación entre la efectividad del tratamiento a base de microvibraciones y con inhibidores de la catepsina K, se realizó una revisión sistemática en nueve bases de datos (Wiley Online Library, PubMed, Google Academic, Scopus, ScienceDirect, SciELO, Medline, EBSCO y Springer Link). La población de estudio fueron ratas y ratones. Resultados: en este estudio se incluyeron 20 artículos cuya investigación se realizó en estudios clínicos. En los resultados podemos observar cómo todos los tratamientos de alguna forma mejoran el proceso de remodelado óseo. Es difícil comparar cuál de los tratamientos dentro de cada grupo es mejor que otro, debido a que los resultados expresados son cualitativos. Conclusión: acorde a los resultados expresados se opta por realizar un tratamiento con microvibraciones debido a que el uso de inhibidores de la catepsina K aún no se encuentra completamente desarrollado y no se comprenden sus consecuencias debido a su manera sistémica de actuar (AU)

Introduction: the bone is in constant remodeling to maintain the skeletal structure, having a cycle of resorption by osteoclasts and formation of new bone by osteoblasts, the bone is also susceptible to systemic diseases, trauma, age and genetic disorders that affect bone remodeling, producing a massive loss of bone mass regulated by hormones, cytokines, enzymes, etcetera. The objective is to perform a systematic review of articles that show a change or alteration when using micro-vibration and pharmacological treatments on cathepsin K in the alveolar bone. Material and methods: in order to make a comparison between the effectiveness of micro-vibration and cathepsin K inhibitor treatments, a systemic review was carried out in nine databases (Wiley Online Library, PubMed, Google Academic, Scopus, ScienceDirect, SciELO, Medline, EBSCO and Springer Link). The study population was rats and mice. Results: this study included 20 articles whose research was carried out in clinical studies. In the results we can see how all the treatments in some way improve the bone remodeling process, it is difficult to compare which treatment within each group is better than the other, because the results expressed are qualitative. Conclusion: according to the results expressed, it is decided that it is better to perform a treatment with micro vibrations because the use of cathepsin K inhibitors are not yet fully developed and their consequences are not understood due to their systemic way of acting (AU)

Picnodisostosis familiar, reporte de un caso tras 10 años de seguimiento / Family picnodisostosis, report of a case after 10 years of follow-up

Resumen: Introducción: La picnodisostosis es una rara enfermedad secundaria en una mutación en el gen 1q21 que codifica la catepsina K, enzima implicada en el metabolismo de osteonectina, osteopontina y colágeno I. La incidencia mundial es de 1-1.7 casos por millón, sin prevalencia por género, se caracteriza clínicamente por talla baja, deformidades craneales, «cara de pájaro¼ y fragilidad ósea con tendencia a fracturas patológicas, que afectan predominantemente los huesos largos y ocasionalmente en los pedículos vertebrales. Radiológicamente es característica la presencia de osteoesclerosis con canales medulares permeables. Aunque existen numerosos reportes de casos clínicos en la literatura, pocos son los que describen familias con más de un individuo afectado y el seguimiento suele ser a corto plazo. Objetivo: Analizar la evolución clínica de los pacientes afectados. Material y métodos: Se realizó estudio retrospectivo, descriptivo, observacional de tres pacientes con diagnóstico de picnodisostosis, en el período de Julio 2006 a Marzo de 2016. Resultados: Se observaron diferentes formas de afectación de la picnodisostosis, algunas de ellas atípicas como la espondilólisis y una fractura de escápula en una paciente. Conclusiones: El presente estudio podría ser el análisis longitudinal más extenso del que se tenga registro. Conocer la variedad de manifestaciones y complicaciones presentadas permitirá al lector seleccionar el mejor método de tratamiento para cada caso.

Abstract: Introduction: Pycnodysostosis is a rare disease secondary to a mutation in gen 1q21 that codifies the cathepsin K, proteolitic enzyme implicated in the metabolism of osteonectin, osteopontin and type I colagen. Its global incidence is around 1-1.7 cases per million, without genre prevalences, it is clinically caracterized by short stature, craneal deformities, «bird's face¼ and bone fragility with pathological fractures tendency predominantly affecting long bones and occasionally vertebral pedicles. Radiologically is characterized by sclerous bones with permeable medular cannel. Despite there are numerous clinical reports on medical literature, just a litlle describe families with more than one afected member and its followship is usually short-term. Objective: To analize clinical evolution of these afected patients. Material and methods: A retrospective, descriptive, observational study was reelized in three patients with diagnosis of pycnodisostosis, between July 2006 and March 2016. Results: different affection forms of pycnodisostosis where observed, some of them, atipical, as for example spondilolisis and a escapule fracture in one patien. Conclusions: The present study could be the longest longitudinal report ever registered. By knowing the presented variety of manifestations and complications, the reader could select the best treatment method for each case.

Sistema adesivo universal: análise da interface adesiva e degradação colagenolítica em dentina submetida à diferentes protocolos de condicionamento ácido / Universal adhesive system: analysis of adhesive interface and collagenolytic degradation of demineralized dentin submitted to different acid etching ptotocols

O objetivo desse estudo foi analisar a interface adesiva do sistema adesivo Single Bond Universal (SBU) em dentina submetida à diferentes protocolos de condicionamento ácido em 24 h e 12 meses. E a degradação colagenolítica (DC) mediada por metaloproteinases (MMPs) e Catepsina-K (CAT-K) em tempo imediato. Esse estudo foi conduzido em 3 etapas: 1) Caracterização química da dentina em FTIR; 2) DC por meio de fragmentos do Telelopeptídeo Carboxiterminal do Colágeno Tipo I (ICTP) e do Terminal C do Telopeptídeo ligado ao Colágeno Tipo I (CTX) e a resistência à tração (RT) da do colágeno; 3) Análise da interface adesiva através da resistência de união (RU), análise de fratura, microscopia eletrônica de varredura (MEV) e nanoinfiltração (NI). Para FTIR foram utilizados 6 discos de dentina, divididos em 2 grupos: 1) Ácido fosfórico 32 %15 s (AF), 2) Ácido poliacrílico 25 % 10 s (AP). Para análise da DC, 12 discos de dentina foram completamente desmineralizados e divididos em 3 grupos: 1) AF, 2) AP e 3) Água deionizada (Controle) 15 s. Após, foram incubados e armazenados por 1 semana. Seguindo-se a análise da concentração de proteína total (PT). 50 µl da solução de incubação foram utilizadas para analisar ICTP e CTX. As concentrações foram calculadas em relação à PT. Para RT, foram testados 36 palitos obtidos dos discos de colágeno. Para RU foram utilizados 48 dentes, divididos em 2 grupos, de acordo com o período de armazenamento, divididos em três subgrupos: 1) AF, 2) AP e 3) Autocondicionante SBU 20 s (SE). Os dentes foram restaurados e armazenados em água destilada 37 °C. Após, foram submetidos ao teste de microtração e análise de fraturas. Para as análises MEV e NI foram utilizados 2 espécimes de cada subgrupo. Para análise estatística utilizou-se ANOVA 1-Fator, ANOVA- 2 Fatores e teste de Tukey (α=0.05). Para FTIR, AF reduziu a quantidade de fosfato e carbonato quando comparado ao AP. Para DC, a liberação de ICTPPT para AF foi significantemente maior do que para AP (p < 0,05). Não houve diferença na liberação de CTXPT para AF e AP (p > 0,05). Para RT não houve diferença entre AP e Controle, porém, apresentaram valores maiores do que AF (p<0,05). Para RU em MPa, não houve diferença estatisticamente significativa para todos os tratamentos nos diferentes períodos de análise (p < 0,05). A análise de fraturas evidenciou a predominância de fraturas adesivas e mistas. MEV mostrou melhor qualidade da interface após 12 meses para AF e AP. Após 12 meses apenas SE não apresentou NI. Assim sendo, o autocondicionamento ainda parece ser a melhor opção para sistemas adesivos universais que possuam monômeros funcionais em sua composição.(AU)

The aim of this study was to analyze the adhesive interface of the Single Bond Universal (SBU) to dentin submitted to different acid etching protocols in 24 h and 12 months, and the collagenolytic degradation (CD) by matrix metalloproteinases (MMPs) and Cathepsin-K (CAT-K) in the immediate time. This study was divided into three stages: 1) Dentin chemical characterization by FTIR; 2) CD by release of the collagen telopeptide fragment cross-linked carboxyterminal telopeptide of type I collagen (ICTP), and C-terminal crosslinked telopeptide of type I collagen (CTX) and ultimate tensile strength (UTS); 3) Analysis of the adhesive interface by microtensile bond strength (µTBS), failure mode, scanning electron microscopy (SEM) of the AI, and nanoleakage by SEM (NL). For FTIR, six dentin disks were divided into two groups: 1) Phosphoric acid 15 s (PA), 2) Polyacrylic acid 10 s (PAA). For CD twelve dentin disks were completely demineralized, then were divided into 3 groups 1) PA, 2) PAA, and 3) deionized water (Control) for 15 s. All disks were incubated in a buffered solution (BS) for 1 week. Total protein (TP) concentrations were measured using Nanodrop™ at 280 nm. 50 µl of BS was used to analyze solubilized telopeptide fragments using ICTP and CTX . ICTP and CTX average ratios were calculated in relation to TP concentration (ICTPtp and CTXtp). For UTS, 36 dentin beams obtained from collagen disks were tested. For µTBS, forty-eight teeth were divided into two groups according to the period of storage, then subdivided into three subgroups: 1) PA, 2) PAA, and 3) Self-etch 20 s (SE). After, composite build up, the specimens were stored in distilled water at 37 °C. Two specimens of each group were used for SEM analysis of AI and NL. Data were analyzed by one-way ANOVA, two-way ANOVA and Tukey tests (p<0.05). According to the results of the FTIR etching with PA reduced the amount of phosphate and carbonate when compared to PAA. ICTPtp release of PA was significantly higher A than PAA (p > 0,05). CTXtp showed no difference between the PA and PAA (p < 0,05). For UTS there was no difference between PAA and control, but they were significantly higher (p<0.05) than PA. For µTBS in MPa, there is no statistical difference among all the etching protocols tested, as well in both storage periods of analysis (p < 0,05). The most prevalent failure mode were adhesives associated with mixed. SEM analysis highlighted a better quality of AI after 12 months for PA and PAA. However, after 12 months only SE did not show NL. Then, the self-etching protocol seems to be a better choice regarding universal adhesive systems which have functional monomers in their blend(AU)

Fracturas múltiples de huesos largos en una escolar portadora de picnodisostosis: Reporte de caso / Multiple long bone fractures in a child with pycnodysostosis: A case report

Las fracturas en edad pediátrica son una entidad importante para considerar. Hay enfermedades en que los huesos del niño se fracturan ante traumatismos de menor energía. La picnodisostosis es un tipo inusual de displasia cráneo-metafisaria autosómica recesiva, cuya primera manifestación clínica suele ser una fractura en hueso patológico. Se presenta a una paciente, caucásica, de 9 años de edad, con diagnóstico de picnodisostosis, que ingresó al hospital por fractura del fémur derecho, por un mecanismo de baja energía. Los estudios radiográficos mostraron fracturas del fémur bilateral, fractura proximal de la tibia izquierda y consolidación viciosa en antecurvatum. Esta rara enfermedad se diagnostica a edades tempranas por talla baja, por fracturas repetidas o por traumas de baja energía. Las opciones terapéuticas son limitadas, y no se ha desarrollado una cura definitiva. Es importante, ante un paciente pediátrico con rasgos dismórficos faciales y fracturas en hueso patológico, sospechar displasias óseas, tales como la picnodisostosis y sus diagnósticos diferenciales.

Fractures are an important entity to consider in pediatric patients. There are certain diseases in which bones fracture with a minimal trauma. Pycnodysostosis is an autosomal recessive unusual type of cráneo metaphyseal dysplasia, that presents frequently as fracture in a pathological bone. A 9 year old caucasian female, diagnosed with pycnodysostosis, was admitted with a right femur fracture as a result of a low energy trauma. Radiographic studies showed bilateral femur fractures, proximal fracture and non-union in antecurvatum of the left tibia. Pycnodysostosis is a rare disease, generally diagnosed at an early age by growth restriction, frequent fractures or fractures with low energy trauma. Therapy alternatives are limited, and no permanent cure has been developed. If a patient has dysmorphic facial features and fractures in a pathological bone, it is important to suspect bone dysplasia, such as pycnodysostosis and its differential diagnoses.